Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 016-0002273 | VT |
NPI | 1023276573 |
---|---|
Provider Name | Dr. Shon Christopher Diguglielmo |
First Address | South Burlington, VT 05403-7214 |
Second Address | South Burlington, VT 05403-7214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2008 |
Last Update Date | 30/05/2008 |